A Report Card on Medication and Psychotherapy
Studies show that OCD symptoms are reduced substantially after two months of treatment with SSRI medications in about two-thirds of children who take them. Of all medications tried with children, all of the SSRIs have shown fewer side effects than the tricyclic antidepressant Anafranil (Clomipramine) and the antipsychotics. However, the remaining unknowns about possible long-term side effects of antidepressant or any other psychotropic medications on children make many parents uncomfortable enough to opt for an initial approach of CBT alone, deferring the use of medication until later if deemed necessary.
This is an area where regular reading of OCD-related Web sites and newsletters is highly valuable. A parent can learn about a new medication, or about a study conducted with a different combination of medication and therapy, and then ask a mental healthcare provider whether the new approach might be appropriate for their child.
Studies also confirm that a combination of CBT therapy and SSRI medications is more often the most effective approach for treating children and adolescents with OCD, with the combined CBT and medication approach yielding the longest duration of reduced symptoms. It has also been demonstrated that over half of children with OCD will have a reduction to minimal symptoms after just twelve weeks of combined (optimal) treatment.
The Pediatric OCD Study (POTS)
The most significant of these studies was funded by NIMH, carried out by John March, M.D., at Duke University and Edna Foa, Ph.D., at the University of Pennsylvania, and reported in the October 27, 2004, Journal of the American Medical Association (JAMA). Called POTS, it involved ninety-seven seven- to seventeen-year-olds with OCD who completed twelve weeks of either CBT, the SSRI Zoloft (Sertraline), a combination treatment, or a placebo.
Combining CBT and the SSRI Zoloft proved to be more effective than either treatment alone. CBT alone was superior to Zoloft alone, which, in turn, showed better results than a placebo.
Alert!
It is very common for children with OCD to be afraid of taking medications. Most of the time, these fears have to do with swallowing a pill rather than the effects of the medication. Some medications come in liquid form; others can be pulverized before taking. Speak to your prescribing doctor before you begin any course of medication for OCD if your child has a fear of swallowing pills.
When Treatment Doesn't Work
About 20 to 25 percent of children and adults with OCD show no improvement after treatment with either CBT or medication. If your child falls into this category, you should not lose hope. Your child may have a different result when trying either approach at a later time, when she's older or perhaps more receptive to treatment. Advances in research and new medications are announced on a regular basis. Stay connected to sources of news and new resources about OCD by joining one of the support organizations noted at the back of this book.
